Use of Closed Incision Negative Pressure Therapy After Rotation Flap Closure of Pressure Ulcers

Introduction: Up to 3 million new pressure ulcers (PUs) occur annually in the United States, with an estimated annual cost to hospitals of over $11 billion. The primary method of PU closure is via musculocutaneous flaps; however, previous studies have reported the incidence of wound dehiscence or wound recurrence after flap closure of up to 50% or up to 28%, respectively.

Method: Closed incision negative pressure therapy (ciNPT) is intended to help manage the environment of closed surgical incisions and the surrounding intact skin, but little has been reported regarding ciNPT use on closed incisions at flap margins. In this study, we describe our experiences using ciNPT after rotation flap closures for 14 patients (10 males and four females) with PUs. Patients ranged in age from 33 to 90 years, and comorbidities included paraplegia, diabetes mellitus, and hypertension. Each patient received 1–2 drains, and, after flap closure of each ulcer, ciNPT was applied for an average of 4.4 ± 0.8 weeks with dressing changes occurring weekly. All patients were administered antibiotics, with the average length of hospitalization being 2.2 ± 0.7 weeks. The average time to drain removal in these cases was 11.3 ± 2.6 days. None of the incisions had evidence of dehiscence at the first dressing change, and 12 of 14 incisions had no evidence of dehiscence at the 30-day follow-up. One patient developed a postoperative surgical site infection (SSI) within 30 days and required further surgical intervention, and five of 14 patients developed surgical site seromas within 30 days.

Conclusion: Thirteen of 14 incisions remained closed. These cases further support the use of ciNPT to help manage closed surgical incisions and, more importantly, support the use of ciNPT in maintaining incisional closure of musculocutaneous flap margins after flap closure of this difficult wound type.